Now the real work begins.

[rubato]

On Wednesday 6 million people will begin to have coverage who didn't before and the real work of providing care will start. The temporary glitches in the signup process are past and ahead many states will be finding out whether they have enough qualified MDs, Nurse Practitioners, PAs, RNs and so forth to provide basic care to an expanded base. Will we have enough clinics? Medical Assistants? There is already a lot of work-shifting going on as more duties are devolved from MDs to other, and less limited, resources.

Kaiser-Permamente and the various local Permanente Medical Groups have been doing a lot of advance planning over the past 3 years to try to be ready but there is a lot of uncertainty and nervousness about emergent phenomenon. Most physicians are hearing that if they are on less than 100% schedule now that they'll be working extra units to keep up. This was already started this fall for The Permanente Medical Group (the Northern California partnership) but I have not heard from the NW or SoCal. groups yet. A lot of people are saying that the longer hours will push more MDs into early retirement. I'm not sure how they can be effectively induced to keep working. I don't think material incentives will be very efficient.

The University of California just enrolled the first class in the first new medical school in California in many decades; at UC Riverside. But it will be years before the first class are licensed and through residencies and even then it will be only ca 100 new MDs per year once it gets going (50 for the inaugural class). But the supply of MDs cannot be expanded very quickly and Mass. has already pulled in a lot of English-speaking (and hence licenseable) MDs from the Caribbean, India and elsewhere.

The answers will only be known gradually over the next 6-18 months as the momentum of change increases.

One incremental advantage will be far better tracking of public health issues in something closer to real time; something countries like Denmark have been able to do for decades. Better metrics allows for more timely and focussed responses to changes in vaccination rates, for example. We can target public health education on the groups most in need of it.

http://www.washingtonpost.com/blogs/won ... goes-live/

http://www.washingtonpost.com/blogs/won ... ors-ready/


But these are all good problems to have. And inevitable if we are to stop being the worst in the G-20 and reverse the decline in care.


yrs,
rubato

[oldr_n_wsr]

On Wednesday 6 million people will begin to have coverage who didn't before

Got a source for that? How many of those 6million HAD coverage that was cancelled? Most I would venture to guess. Therefore the immediate impact on the medical community would be minimal. Of course that doesn't mean IF most/all of the people who were not in any insurance plan finally sign up there won't be a burden on the medical community. I am just questioning the 6million "new insurees" number.

I maintain that those who were insured and were cancelled, or shopping around for a better rate, probably make up the bulk of those who signed up for the obamacare.

[Lord Jim]

Got a source for that?

I'll tell you how rube comes up with the grossly misleading numbers he posts on this, oldr...

First he combines the paid exchange numbers (which are already inflated, because they continue to count people who have enrolled but not paid; some percentage of which will obviously never pay and therefore won't really be enrolled) with the medicare numbers, and then he uses this source:

http://acasignups.net/

(I see the format has changed a bit; you need to click on the "spread sheet" button when you get to that page.) If you scroll over to the final column, you will see a huge number of qualifiers relating to many of the numbers that make clear that the total is not some sort of accurate snapshot of the situation. Rather it is a "best case scenario" including many extrapolations, projections and some things that are very unlikely.

For example, next to the totals for Washington state, you'll find this caveat:

*65,472 had enrolled & paid; 69,606 had enrolled but not paid yet as of 12/24

The combined number is used for the total. (This also indicates that while the administration refuses to provide the national breakdown on what percentage of those who have signed up for the exchanges have not actually paid, it is likely to be quite substantial.)

There's nothing dishonest or unethical with whoever compiled this report doing it this way, since they are quite honest about the limitations on the validity of the numbers they report.

The dishonesty and lack of ethics belong to rube, who continuously misuses this report, and posts these combined inflated numbers as established fact.

A real scientist (or any person with even a minimal regard for truth) would be ashamed to brazenly misuse data in this way, but obviously it provides no problem for our rube.

So whenever he reposts these claims the thing to do is read whatever he posted as "Here's some more complete bull shit from me. I think you won't be bothered to look at the actual spread sheet, so I believe I can get away with lying about what it means." and shine it on...

ETA:

In order see the relevant column, after you press on the button for the spread sheets, you'll need to scroll down to the bottom, and then scroll over using the page's scroll bar.

[oldr_n_wsr]

Been looking at that. What does (thru 12/23: auto-expansion by state, not via exchange) mean?
And this?

(thru 12/11=45K total; assuming 52/48 private/Medicaid based on 11/30 totals); 1,700 = on 12/23 specifically

assuming?????

and

Additional
Enrollments
Not Broken Out
By State

Aliens?
They have no state? of being?

[Lord Jim]

All very legitimate questions oldr, but don't wait around for rube to answer them...

Whenever rube's bullshit assertions about this have been challenged with fact based criticism, rube never replies to the substantive questions...(not really surprising, since his intent is to deceive and he knows it.)

No, what rube is likely to do next in this thread is what he's always done when confronted with specific logical questions about this...

Ignore the questions, switch gears and attack the questioner with some version of "your answer for healthcare is for everybody to die!"....

Then he'll pop up again trying to pass the same BS off as established fact, continuing to ignore the questions...

He does this because he has absolutely no interest whatsoever in what the facts are about how this is going; all he wants to do is propagandize for it, and for that narrative to work, everything has to be going fantastically well, the facts be damned...

For rube, facts are not just stubborn things; they're a damn nuisance....

[oldr_n_wsr]

One would think the creator of this spreadsheet would put footnotes to explain these "remarks". I have done my share of spreadsheets and always bent over backwards for it to be as clear as possible for the reader. Putting it out on the internet would mandate absolute clarity on my part with all notes/descriptions explained fully.

[rubato]

Based on the Massachusetts experience as well as the Medicare rollout in 1966 there is little to be afraid of. Although my spouse is hoping not to lose her 80% schedule (usually closer to 90% for the past 6 years as filling in for emergencies adds up.).


http://www.washingtonpost.com/blogs/won ... /mass3.png

"... Even before the Affordable Care Act kicked in, some patients had difficulty finding a doctor who would accept their coverage. This is especially true with Medicaid, where 30 percent of doctors are not currently accepting new patients. The problem is particularly acute in states that pay Medicaid doctors much lower rates than the Medicare program.




"There is a shortage of primary-care physicians," says Reid Blackwelder, president of the American Association of Family Physicians. "It's a crunch."

Leighton Ku, a researcher at George Washington University who has spent decades studying insurance expansions, remembers when he had to switch health plans a few years ago.

"When I came over to GW, I had to go find a primary-care doctor," he says. "The first five primary-care doctors said they were not taking new patients. And this is something that will happen in the exchanges too, where providers listed in directories will say that. This has been a traditional problem."

In other words, we're starting from a baseline where patients already face challenges finding doctors. The question about health reform, then, is whether it makes those challenges greater.

More broadly, Ku does expect a lot of confusion -- about which doctors patients can see, and who is covered by what insurance plan -- in the first days and weeks of 2014. That's true of any insurance expansion, he says, and has more to do with a really big change to the health-care system than an actual capacity issue.

"I remember many years ago being in Hawaii for a big Medicaid expansion," Ku says. "I was wandering around their Medicaid agency, and every telephone was ringing constantly because there were so many questions people had. Doctors had questions, insurers had questions, pharmacists had questions. Then it calmed down."

Massachusetts may offer the best proxy for understanding how the insurance expansion will go. Annual surveys by the Massachusetts Medical Society don't show an especially clear pattern on access to care. There has definitely been a big drop in internists accepting patients, from 66 percent in 2005 to 45 percent this year. The wait time to see an internist has bounced around a lot, showing no clear pattern related to the state's insurance expansion.



But at the same time, there's been an increase in ob-gyns taking on new cases (from 71 percent in 2005 up to 84 percent today.)



Jha, the Harvard professor, has explored the Massachusetts expansion from a different angle. His research, published in the journal Health Affairs, looked at Medicare patients' access to primary care. He and his colleagues were trying to see whether the insurance expansion, bringing millions of new patients coverage, made it more difficult for the elderly to access their primary-care doctor.

They found no change; seniors had just as easy of a time getting in to see their doctors after the expansion as they did before. And they didn't experience any declines in their quality of health care, either.

"The big picture is that we really see no impact whatsoever on access to care or quality of care for everyone else," Jha says. "That is certainly the case for Medicare beneficiaries."

Jha thinks that part of the explanation is the health-care system having more capacity than we give it credit for, meaning that doctors have the space to fit more patients into their schedules. "One of the things that's a fallacy is that there's a fixed amount of care the population needs," Jha says. "That turns out not to be true. If doctors have lots of open slots, they'll see patients more. But if you don't see them, they'll probably wait six months and be fine."
...
"What will happen then, on that summer day when the federally insured system of paying hospital bills becomes reality?" Nona Brown, a New York Times reporter, wondered in a story published April 23, 1966. "Will there be lines of old folks at hospital doors, with no rooms to put them in, too few doctors and nurses and technicians to care for them?"

MedicareClip3

What happened was, well, not much. "Medicare takes over easily," was the headline in the Washington Post on July 2, 1966. "It was a smooth transition," Dan Morgan and Martin Weil wrote, describing the local scene as "undramatic."

yrs,
rubato